30 months, 59 consecutive patients treated surgically forintestinal failure at St Mark’s Hospital, London, UKOne of two intestinal failure units in the UK. Surgical team associated with dedicated IF unit run primarily by gastroenterologists. Support from specialist nursing staff, stomal therapists, dieticians, social-workers, pharmacist. Weekly team meetings including all disciplines. Well developed infrastructure to manage long term home TPN patients.
Aetiology of intestinal failure in the 59 patients studied
Aetiology of short bowel syndrome. Crohn’s patients developed short bowel due to multiple previous small bowel resections.
Breakdown of aetiologies of enterocutaneous fistulation in our series. Postoperative27 Emergency 22 Diverticulosis8Mesenteric ischaemia 5 Adhesions4 Ulcerative colitis3Sigmoid volvulus 1 Colonic bleeding 1 Elective5 Endometriosis1Nissenfundoplication 1Colorectal malignancy1Loop ileostomy 1Hysterectomy1 Crohn’s disease13 (primary fistulation, not iatrogenic)Trauma 2 (penetrating trauma)
Complex enterocutaneous fistula following laparostomy.
Time to definitive surgery = time from last operation to time of first definitive surgery at St Mark’s Hospital
All results quoted as median + rangeNumber of operations = at St Mark’s HospitalAbdominal wall defect = unable to achieve fascial closure (all 9 ECF patients with prevlaparostomy). Abdominal wall reconstruction with inlay absorbable mesh.
Recurrent enterocutaneous fistulae 2 healed with conservative management2 required re-operation with success1 re-operation abandoned => persisting ECFVentral herniae – 11/12 were ECF patientsPost-op sepsis (severe)3 pulmonary3 line related
If Presentation Asc
“Intestinal failure results from obstruction,
dysmotility, surgical resection, congenital
defect, or disease-associated loss of
absorption and is characterized by the
inability to maintain protein-energy, fluid,
electrolyte, or micronutrient balance.”
O’Keefe SJD, Buchman AL, Fishbein TM, Jeejeebhoy KN, Jeppesen PB, Shaffer J. Short Bowel Syndrome and
Intestinal Failure: Consensus Definitions and Overview. Clin Gastroenterol Hepatol 2006; 4: 6-10.
Retrospective review of single-surgeon
results at a UK National Intestinal Failure
July 2005 – December 2007
Median age 47 yrs
88 surgical interventions
Median follow up 268 days